Tiraje Celkan1, Hande Kizilocak1, Melike Evim2, Adalet Meral Güneş2, Namik Y Özbek3, Neşe Yarali3, Ekrem Ünal4, Türkan Patiroğlu4, Deniz Yilmaz Karapinar5, Nazan Sarper6, Emine Zengin6, Serap Karaman7, Ülker Koçak8, Emin Kürekçi9, Canan Özdemir10, Deniz Tuğcu7, Ezgi Uysalol11, Gürcan Dikme1, İbrahim Adaletli12, Sebuh Kuruoğlu12, Rejin Kebudi1,13. 1. Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa. 2. Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University, Bursa. 3. Ankara Pediatric Hematology-Oncology Training and Research Hospital. 4. Division of Pediatric Hematology-Oncology, Faculty of Medicine, Erciyes University, Kayseri. 5. Division of Pediatric Hematology-Oncology, Faculty of Medicine, Ege University, Bornova. 6. Division of Pediatric Hematology-Oncology, Faculty of Medicine, Kocaeli University, Izmit. 7. Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine. 8. Division of Pediatric Hematology-Oncology, Faculty of Medicine, Gazi University. 9. Lösante Pediatric Hematology Hospital, Ankara. 10. Division of Pediatric Hematology-Oncology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey. 11. Division of Pediatric Hematology-Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul. 12. Division of Pediatric Radiology, Cerrahpaşa Faculty of Medicine. 13. Division of Pediatric Hematology-Oncology, Oncology Institute, Istanbul University.
Abstract
BACKGROUND: Invasive fungal infections, including hepatosplenic fungal infections (HSFI), cause significant morbidity and mortality in children with leukemia. There are not enough data to support for the best approach to diagnosis of HSFI in children, nor for the best treatment. PROCEDURE: In this multicentric study, we assessed the demographic data, clinical and radiologic features, treatment, and outcome of 40 children with leukemia and HSFI from 12 centers. RESULTS: All cases were radiologically diagnosed with abdominal ultrasound, which was performed at a median of 7 days, of the febrile neutropenic episode. Mucor was identified by histopathology in 1, and Candida was identified in blood cultures in 8 patients. Twenty-two had fungal infection in additional sites, mostly lungs. Nine patients died. Four received a single agent, and 36 a combination of antifungals. CONCLUSIONS: Early diagnosis of HSFI is challenging because signs and symptoms are usually nonspecific. In neutropenic children, persistent fever, back pain extending to the shoulder, widespread muscle pain, and increased serum galactomannan levels should alert clinicians. Abdominal imaging, particularly an abdominal ultrasound, which is easy to perform and available even in most resource-limited countries, should be recommended in children with prolonged neutropenic fever, even in the absence of localizing signs and symptoms.
BACKGROUND:Invasive fungal infections, including hepatosplenic fungal infections (HSFI), cause significant morbidity and mortality in children with leukemia. There are not enough data to support for the best approach to diagnosis of HSFI in children, nor for the best treatment. PROCEDURE: In this multicentric study, we assessed the demographic data, clinical and radiologic features, treatment, and outcome of 40 children with leukemia and HSFI from 12 centers. RESULTS: All cases were radiologically diagnosed with abdominal ultrasound, which was performed at a median of 7 days, of the febrile neutropenic episode. Mucor was identified by histopathology in 1, and Candida was identified in blood cultures in 8 patients. Twenty-two had fungal infection in additional sites, mostly lungs. Nine patientsdied. Four received a single agent, and 36 a combination of antifungals. CONCLUSIONS: Early diagnosis of HSFI is challenging because signs and symptoms are usually nonspecific. In neutropenicchildren, persistent fever, back pain extending to the shoulder, widespread muscle pain, and increased serum galactomannan levels should alert clinicians. Abdominal imaging, particularly an abdominal ultrasound, which is easy to perform and available even in most resource-limited countries, should be recommended in children with prolonged neutropenic fever, even in the absence of localizing signs and symptoms.